Authors: Carol Cassella
The girl now lying
on my operating room table looks like some kind of dark angel. Her skin is young enough to be unblemished and smooth as browned butter. Her eyelashes sweep above her zygomatic bones in feathery black arcs. Her nose still has the full rounded tip of childhood, just beginning to lengthen and straighten, and her ears are as identically matched as two halves of a heart. Her hands curl in the relaxed posture of deep anesthetic sleep, the nails are tissue paper moons.
Looking down the length of her sinewy, proportioned body, her legs splayed just to the comfortable angle allowed by her pelvic girdle, it is impossible not to appreciate how inconsequentially minute is her single imperfection. How can I see anything except the miracle of the millions of bits of genetic code that cobbled together food, water and air into this almost perfect human being? An oxygen saturation monitor beeps with the rhythm of her pulse, its high tone reassuring me that she is safe in her suspended state—a sleeping princess awaiting her prince.
I have come to a place as steamy as any August day in Houston: Porbandar, Gujarat—Gandhi’s birthplace, on the Sabarmati River. I accepted a job at a teaching hospital back in Seattle on the condition that I could spend three months abroad as a volunteer working with a small team of pediatric surgeons repairing cleft palates and fistulas and clubfeet.
Some days we operate on more than twenty children, in addition to running a pre-op and post-op clinic, and I go back to my single bed so exhausted I sleep through till morning without realizing time has passed at all. We brought crates of medical supplies from the U.S., and still the working conditions approximate an era decades before I did my residency: a finger on the radial pulse, a stethoscope taped over the chest wall, a glance at the nail beds or conjunctiva to estimate oxygen levels and hematocrits when the electricity blips off. We are a mixed group of doctors and nurses, six from the States, four from other regions in India, three from Europe. Over the few weeks I’ve been here we’ve become best friends, all of us, in the unique way that unusual circumstances and stress can foster extraordinary bonds.
Lori sends me letters every few days. They always start with a paragraph or two about Dad and how he’s coping with her kids. He gives them history lectures at the dinner table every night. She writes that Neil actually seems interested, Lia usually falls asleep (but he can’t see her clearly enough to tell, so his pride isn’t hurt), and Elsa would rather hear critiques of fifteenth-century Medician social constructs than his criticisms about her clothes or musical tastes. From there on her letters ramble for pages about everyday domestic life—our correspondence seems to have evolved into a therapeutic journal for her. For me, the letters are movies and television and computers and radio. They have all those things here, in sputtering and intermittently transmitted Hindi, but I prefer the peace of pen and ink for a while.
Dad began calling me more often after I flew home from Houston to meet with Charlie—telling me how the repairs on his house were progressing, what great new frozen dinner he’d discovered, or complaining that the housekeeper I hired for him insisted on scrubbing out every stain in his carpet and every corner in the kitchen cabinets so the whole house smelled like white vinegar. One evening, at the end of a detailed discussion of the weather forecast, he asked me to help him sell his house. He said Lori had put him on the waiting list for an assisted living apartment in Fort Worth, and in the meantime he would stay in her guest room. But when Charlie told me there was an opening in the building his parents live in, I put a deposit on it. After I return from India I will help my father move to Seattle.
My father and I seem to be discovering, or perhaps inventing, a different relationship, rather than attempting to work through our history. We haven’t said that to each other—he is not from a generation that talks things out to clear the air. But we are both learning to hear each other, finally, beyond our words.
There is a formula that calculates the delivery of oxygen to the tissues in the human body, a tidy package of numbers that attempts to quantify how much oxygen we can extract out of invisible air and squeeze through our nearly infinite capillaries with every beat of our hearts. Give me some measurable facts—the concentration of red blood cells, the inhaled mixture of oxygen and nitrogen, the volume of blood jetting out of the heart at each contraction—and with a few punches on a calculator I can determine whether or not the sum total is sufficient to sustain life. As long as no numeral slips too far toward zero, the calculation predicts we will awaken from our biopsies and arthroscopies and bypasses to return to work, create, love and reproduce, with only a scar to remind us of the violation.
Condensing it to a formula, of course, belies the art of my profession—tailoring the drugs and drips and pain relief, even my words, to conjure the ideal anesthetic, unique to each patient. An ideal anesthetic should be almost imperceptible, dissolving into the background like the painted blue sky of a stage set. It should appear as effortless as a ballerina’s pirouette, or the volley of a tennis champion. When it works, when all the components blend in perfectly balanced proportion, my job becomes oddly intimate—a shared personal secret with a stranger, watching them wake up with an expression in their eyes I recognize as stark disbelief that time has passed and this frightening event is over. They have crossed this barrier and emerged intact, if changed in some indefinable way, opened up and explored, on the other side.
My dark angel, this almost perfect child, has a deep groove incising her palate and upper lip just to the right of the midline and extending up into the right nares. The surgeon has spent two hours opening the flesh and resuturing it along the fresh, raw edges to create a new mouth. It is not a perfect mouth, but a functional mouth that will allow her to eat and drink normally, to talk, someday to kiss. He puts antibiotic ointment over the interrupted line of black silk holding her stitched skin together, and I let her begin to breath; I turn down my anesthetic gas in the same way a pilot might glide onto a landing strip. As her sleep lightens, the effort of her breath rises up the length of her torso, from her abdomen, to her chest, to her clavicles and the sternocleidomastoid muscles that join her head and thorax. She is light enough now that I can carefully withdraw her endotracheal tube and place my fingers beneath the angle of her mandible to open her airway. She begins to swallow, her eyebrows flicker, and the lashes overlying her cheeks twitch as her brain emerges from anesthetic sleep into consciousness. She is almost here, barely below the threshold of response, just close enough to hear me, and I whisper in her ear: “
Ootho buchche, ootho. Aap kaa operation khatam ho gayaa hai. Sub kuch theek gayaa, aur aap bilkul theek honge.
” Wake up, little one. Wake up. Your operation is over. Everything went well, and you are doing just fine.
A novel is created in the solitary world of the writer’s mind, but brought to life through the support of an entire community. I would never have started this work without the coaching and encouragement of author Michael Collins. He and other teachers at Field’s End writing community on Bainbridge Island helped me turn a dream into words. Carole Glickfeld, Michael Byers, David Guterson and Priscilla Long all have shared their unique talents for the benefit of new writers. My thanks also to Loretta Barrett, Mark White, and my ever-patient writing partners Dennis O’Reilly, Suzanne Selfors, Jonathan Evison, Susan Wiggs, Elsa Watson, Anjali Banerjee and Sheila Rabe for wise feedback on language and storyline. Thanks to everyone at Inkwell Management and my agents, David Forrer and Kim Witherspoon, who believed in me enough to invest their time, energy and endless cheerleading. My editor, Marysue Rucci, devoted many patient hours sculpting my words closer to my personal best. I am so grateful for her vision and faith; she offered sage advice even when I was reluctant to listen. Ginny Smith, Victoria Meyer, Jonathan Evans, and the entire staff at Simon & Schuster have made this a superb and seamless experience.
Thanks also to my friends, who have read countless early drafts of this book: Anne Gendreau, Julie Kriegh, Bryce Holmes, Sherry Holmes, Beth Hendrickson, Doug Nathan, Helen Hendrickson, Mary Katherine Bywaters, Deborah Hickey-Tiernan, Cynthia Seely, and Zan Merriman.
I have attempted to write this fictional story as realistically as possible. For that I have depended on numerous advisers, all of whom generously offered their help. Thanks to Nancy Nucci, Kevin Trum-bolt, David Steefel, Bob Ransom, Karen Roetman, Jon Ferguson, Manir Batra, Ann Marie Gordon, Dan Gandara, Katherine Galagan, Corrynne Fligner, Karen Weiss Hanten, Todd Schneiderman, and Prem Pahlajrai.
Without the lifelong support of my family I would have achieved nothing. All my love to Ray and Kathie Wiley, Marilyn Wiley and Ellen Bywaters. Steve, without you I would have no words and no reason to write. You make it all worthwhile.
Fiction explores the boundaries of our lives, the
magnifying imperfection in order to wake us up to the majesty of the commonplace. This book is about no actual person and, if I have done my job, it is equally about each one of us. In the twenty-five years I have studied and practiced medicine I’ve worked with hundreds of doctors, nurses and technicians, and cared for thousands of patients. They have affirmed my belief in the compassionate core of human nature. As with any humanly engineered and delivered concept, the juggernaut of health care is both awe-inspiring and flawed. People are not perfect. But I am routinely humbled by the dedication, goodwill and endurance of the people who have chosen this career. They do it because they care.
Carol Wiley Cassella lives in Bainbridge Island, Washington, with her husband and their two sets of twins. She is a practicing anesthesiologist and medical writer, and is currently working on her next novel.